Gastrostomy and jejunostomy tubes are used to deliver nutritional products to the gastrointestinal tract of a patient having difficulty ingesting food. Gastrostomy tubes deliver the nutritional products percutaneously from an external source, through the patient's abdominal wall, and directly to the patient's stomach, while jejunostomy tubes deliver the nutritional products percutaneously into the patient's jejunum or small bowel. Gastrostomy and jejunostomy tubes are referred to collectively herein as "feeding tubes."
The first step in placing a feeding tube in a patient typically involves the passing of an endoscope down the patient's esophagus in order to view the esophagus and determine whether there are any obstructions or lesions in the esophagus that will inhibit or preclude passage of the feeding tube through the esophagus. The endoscope also is used to examine the interior of the stomach and/or the small bowel. Next, the doctor selects the site through which the feeding tube will be introduced and transilluminates the selected site by directing light outwardly from the endoscope such that the light shines through the patient's abdominal wall, thereby allowing the doctor to identify the entry site from a point outside of the patient's body. The doctor then makes an incision through the patient's abdominal wall into the stomach and passes a first end of a wire percutaneously into the stomach. The first end of the wire is grasped using a grasping tool associated with the endoscope, and the endoscope and the wire are drawn outwardly from the patient's stomach and esophagus through the patient's mouth. Upon completing this step of the procedure, a second end of the wire remains external to the patient's abdominal wall while the first end of the wire extends outwardly from the patient's mouth.
In one technique for feeding tube placement, the first end of the wire is attached to a first end of a feeding tube. By pulling on the second end of the wire, the feeding tube is pulled through the patient's mouth and esophagus, and into stomach. Further pulling of the second end of the wire causes the first end of the feeding tube to exit percutaneously from the stomach through the tract in the abdominal wall. The feeding tube is pulled outwardly through the tract until a retaining member mounted on the second end of the feeding tube engages the interior of the stomach. This technique is referred to as a "pull" technique.
In an alternative technique for feeding tube placement, a channel through the feeding tube is placed over the wire such that the feeding tube can be pushed along the length of the wire. As the feeding tube is pushed over the wire, it passes through the patient's mouth, esophagus, and stomach until the first end of the feeding tube exits through the incision in the abdominal wall. The feeding tube is then drawn outwardly through the abdominal tract until a retaining member on the second end of the feeding tube engages the interior of the stomach. The wire is then withdrawn from the patient through the feeding tube channel. This technique is referred to as a "push" technique.
Feeding tubes used with push and pull placement techniques define a feeding lumen therethrough. The feeding lumen is open to an external environment of the feeding tube at the second end of the tube, i.e., at the end of the tube proximal the retaining member. The first end of the feeding tubes placed using the pull technique is closed and preferably has a substantially conical shape in order to act as a dilator as the first end of the feeding tube is drawn through the incision. Thus, the feeding lumen of tubes placed using the pull technique is not open to an external environment of the feeding tube at the first end of the feeding tube.
Following placement of the feeding tube using either the push or the pull technique, the doctor typically inserts the endoscope again through the patient's mouth and esophagus in order to confirm the position and the orientation of the retaining member and feeding tube within the stomach.
In order to minimize the trauma to the patient associated with placement of the feeding tube, it is desirable to employ a feeding tube placement technique that reduces or eliminates the need to pass devices through the patient's esophagus, either into or from the stomach. As above-discussed, the push and pull techniques require at least five (5) separate one-way passes of devices through the esophagus, four (4) of which are attributable in whole or in part to scoping the patient prior to and following placement of the tube.